Overweight and Obesity ICD-10-CM Coding

Overweight and obesity are abnormal or excessive fat accumulation that may impair health. These conditions put a patient at a higher risk for many health problems, including coronary artery disease, hypertension, type 2 diabetes mellitus, cholelithiasis, and breathing problems.

Body mass index (BMI) is an index of weight-to-height. It is calculated as a person’s weight in kilograms, divided by the square of the person’s height in meters (kg/m²). The World Health Organization (WHO) uses the following measures:

BMI greater than or equal to 25 is overweight

BMI greater than or equal to 30 is obese

The relevant ICD-10-CM codes are located in category E66, and are organized severity, contributing factors, and manifestation:

E66.01 Morbid (severe) obesity due to excess calories

E66.09 Other obesity due to excess calories

E66.1 Drug-induced obesity: There is an instructional note that states to use an additional code for adverse effect, if applicable, to identify the drug (T36–T50 with a fifth or sixth character 5)

E66.2 Morbid (severe) obesity with alveolar hypoventilation

E66.3 Overweight

E66.8 Other obesity

E66.9 Obesity, unspecified

Instructional notes at the beginning of the category state to code first obesity complicating pregnancy, childbirth, and the puerperium, if applicable (O99.21-); and, to use an additional code to identify the body mass index (BMI), if known (Z68.).

The body mass index codes are in category Z68. There are codes for adult BMI and codes for pediatric BMI. The adult codes are based on the numerical scale (e.g., 28.0–28.9), and the pediatric scale is based on the percentile for age range (e.g., 5th percentile to less than 85th percentile). BMI adult codes are for use for persons 21 years of age or older and the pediatric codes are for use for persons 2-20 years of age.

EXAMPLE

Subjective: A 49-year-old woman presented for weight loss treatment. She has attempted to lose weight through a variety of diets but has had no meaningful success. She states that she “loves food” and particularly is “addicted to sweets.”

Objective: On exam, she was 64 inches tall and weighed 230 pounds, yielding a body mass index (BMI) of 39.5.

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

It’s my understanding that the term “morbid” is used if the patient has one or more comorbid conditions that are either caused by or made worse by the patient’s obesity. A patient can have a BMI of 35 but considered morbidly obese if he/she has diabetes, heart disease, COPD, etc. I think it’s really up to the doctor (and what he/she says in the medical record) as to whether you code obesity as “morbid” or not.

I happened to run onto this thread actually searching for something else. Everyone, I hope, has probably had this clarified by now but just in case someone else runs onto it and hasn’t….the reason you code E6601 (Morbid obesity) is simply because that is what the doctor has documented in the assessment.
“Assessment: Severe obesity due to excessive caloric intake”. SEVERE” obesity codes to E66.01 Morbid obesity. Never choose the code by the BMI provided. Only code by the documentation provided by the physician.